• Make sure that medications such as Benadryl aren't on your OR's
easy-to-order medications list. At the facility where I work, we're
working on a protocol that if an older patient screens positive for cog-
nitive impairment, we plan to prompt the provider to consider other
options before ordering Benadryl.
• Don't routinely give benzodiazepines as a presedative or sedation
to patients 70 years and older. Benzodiazepine use is associated with
post-operative delirium.
• Remove meperidine (Demerol) from order sets. Meperidine is a
poor drug for control of pain in elderly patients because it is less like-
ly to provide appropriate levels of pain control and because it can
lead to delirium or seizures.
• Instruct elderly patients to check with their physician before tak-
Anesthesia Alert
AA
2 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A Y 2 0 1 8
Here's a chicken-or-the-egg question to ponder: Are the drugs
administered during anesthesia or the surgery itself responsible
for post-op cognitive decline (POCD)?
Researchers have examined whether the type of anesthetic
used during surgery or the depth of anesthesia affects the risk of
developing POCD. So far, results have been inconclusive.
There's another school of thought that subscribes to the theory
that the stress of surgery is responsible for POCD more so than
the effects of anesthesia. Some evidence suggests the body's
inflammatory response to surgery likely plays an important role,
but further research is needed to determine what actions you can
take to lessen the possible deleterious effects of inflammation,
such as administering anti-inflammatory agents before surgery
or using regional anesthesia. — Lee A. Fleisher, MD
ANESTHESIA OR SURGERY?
What's Responsible for Post-op Cognitive Decline?
